title: Attitudes to knee osteoarthritis and total knee replacement in Arab women: a qualitative study.
abstract: BACKGROUND
  Total Knee Arthroplasty (TKA) is offered to patients with knee osteoarthritis (OA) in the oil-rich countries in the Gulf region without adequate understanding of their perceptions, preferences or pain experiences. This study aimed to explore the pain experience and mobility limitation as well as the patient's decision making process to undertake TKA among women with knee pain in the waiting list for surgery.
  
  
  METHODS
  Five focus group discussions were conducted comprised of 39 women with severe knee OA from the waiting list for TKA in the only orthopaedic hospital in Kuwait. Discussions were recorded, transcribed and coded for themes to identify the factors considered to be important in decision-making for TKA.
  
  
  RESULTS
  Experiencing knee pain was central to daily living and affected patients and their families. Mobility limitation was shaped by a strong sense of expected obligation to take care of the family. Two major sources of TKA delay were identified; one was due to late clinical advice to undergo TKA which was the result of receiving several consultations from different clinicians each of whom tried the medical management for OA. The second delay occurred after the clinical advice for TKA and was mainly due to ambivalence of patients because of fear of the operation and the lack of information about TKA that resulted in unclear expectations of the surgery.
  
  
  CONCLUSIONS
  Both verbal and written information about TKA should be provided as part of preoperative rehabilitation. This is critical to improve doctor-patient interactions and facilitate informed decision about the procedure and thus achieve patient-centered healthcare.
authors.affiliation: Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Box: 24923, Safat 13110, Kuwait. altaiar@hsc.edu.kw.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Taiar
authors.forename: Reem
authors.initials: R
authors.lastname: Al-Sabah
authors.forename: Ehab
authors.initials: E
authors.lastname: Elsalawy
authors.forename: Dia
authors.initials: D
authors.lastname: Shehab
authors.forename: Shaima
authors.initials: S
authors.lastname: Al-Mahmoud
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D003657:Decision Making; D003710:Demography; D005190:Family; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007730:Kuwait; D008875:Middle Aged; D051346:Mobility Limitation; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery*; D010146:Pain / Q000150:complications; D036301:Qualitative Research